周術期のリハビリテーション中に発生した致死的肺塞栓症

概要

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Fatal pulmonary embolism is a well known complication of various disorders, including orthopedic surgical cases. We present two cases of pulmonary embolism occurring in the perioperative periods. Case 1: A 66-year-old woman suffering from intradural-extramedullary tumor at the level of Th 9 complained of gait disturbance. On the sixth day after tumor resection, cardiopulmonary arrest occurred immediately after muscle manual test of lower limb. She expired despite resuscitation. Pulmonary embolism was suggested. Case 2: A 80-year-old woman suffered from right hip fracture. Six days after admission, she experienced dyspnea and chest pain during muscle strengthening exercise of upper limb. Pulmonary embolism was diagnosed based on defective images in the right upper lobes on urgent pulmonary blood flow scintigram. Her clinical status improved with urgent anticoagulation therapy (with heparin). Special attention should be paid to prophylaxis of pulmonary embolism in patients in the perioperative periods. Intermittent pneumatic compression and therapeutic exercises offers advantages over pharmacological prophylaxis against venous thromboembolism-namely, safety, absence of bleeding complications, and efficacy in reducing calf thrombosis. Early rehabilitation should be recommended by means of thromboprophylaxis.
社団法人日本リハビリテーション医学会の論文
2001-01-18